Minimally Invasive Surgery for Adult Scoliosis: Recent Updates and Advancements

Circumferential minimally invasive surgery (cMIS) for adult scoliosis has evolved over the past five years. Here, we review how advances in patient selection, operative technique, and technology have transformed the capabilities of cMIS for deformity.

Early cMIS was constrained by a "corrective ceiling" that limited its use to flexible deformities. Patient selection has since grown more nuanced, incorporating surgical complexity, patient-specific factors, and the deformity itself rather than radiographic thresholds alone. Technique has changed in parallel, as correction is now distributed across multiple interbody levels with segmental release, performed through both anterior and lateral techniques. Workflow and technology have adapted as well: single-position prone transpsoas and lateral prepsoas approaches may reduce intraoperative repositioning, staging extends treatment to patients with greater deformity or frailty, and robotics and patient-specific implants improve the precision of planning and execution. These advances have been accompanied by data demonstrating improved patient-reported outcomes and spinopelvic alignment at lower morbidity in appropriately selected patients. With the safety and efficacy of cMIS established, the field continues to push its boundaries toward more challenging pathology, as illustrated by contemporary cases of severe multiplanar deformity and complex revision. The boundaries of cMIS have expanded considerably beyond the flexible, moderate deformities for which these techniques were initially developed. Careful patient selection remains essential, as not all deformities are amenable to minimally invasive correction. Nevertheless, advances in surgical technique, operative workflow, and patient-specific planning have enabled increasingly severe and complex deformities to be addressed while preserving the fundamental advantages of minimally invasive surgery.